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General NPI Number Information
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NPI Number | 1932169356
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Entity Type | Individual
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Provider Name | PHILIP P BUCK PA
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Gender | Male
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 06/22/2021
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Provider Practice Location Address
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Address Line | 1638 OWEN DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3424
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Country | US
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Telephone | 910-609-6350
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Fax | 910-609-5278
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Provider Business Mailing Address
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Address Line | PO BOX 1070
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City | CHARLOTTE
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State | NC
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Zip | 28201-1070
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Country | US
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Telephone | 800-476-8646
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Fax | 919-382-3210
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA02760
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 101930
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5395
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License Number State | AZ
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